Who, What to believe? Confused - HELP

[Freddie]

Lets start at the beginning: INR - 2.5 to 3.5
5mg on Fridays & Sundays, 6mg for the other 5 days = 40mg/wk

Two weeks ago INR was 3.0/home monitor, 2.7 lab draw
Today, home monitor 4.3, lab draw 4.1 What has happened is that I've had a cold for the past week and not eating very well - that explains the higher INR.

BUT here's the problem; went to a doctor today (not my usual doctor) and she prescribes to me DOXYCYCLINE 100mg twice a day and feels that it would knock up my INR higher, so being a little high today and starting this new drug she has decreased my dosage to 5mg everyday until next Tuesday and get re-tested to see where I stand.

Now I'm thinking that's a big decrease. My pharmacist and Al Lodwick indicate that the interactions with this drug and warfarin is mild, granted each person is different and my INR will go up when I take amoxicillin.

So what does one do?
Take 5mg until Tuesday and see where I'm at or alternate 5mg and 6mg until Tuesday?
I usually test on Thursday mornings, and will test Tuesday morning, so Tuesday dosage will not be taken.
humm: 5mg x 5 = 25mg (Thursday (today) to Monday)
or 5+6+5+6+5 = 27mg
compared to, if I was to test on Thursday:
5mg x 6 days = 30mg
or alternating 5mg & 6mg for 6 days = 38mg

Hope I haven't gotten you all confused, but I'm thinking a small decrease in dosage is better than a big one IF this new drug will effect my INR.

What to do?
As always, your input is greatly appreciated,
Thanks,
Me

 

[geebee]

Hi Freddie,

I only adjust my coumadin for drugs that I know affect my INR from past experience. If it is a new med, I will continue on my regular coumadin dose and test a few days after starting the new med.

 

[Ross]

Amoxicillin does NOT affect INR. I would do no adjusting until it's proven that your INR is going up or down.

WARFARIN SODIUM (in Coumadin Tablets) may interact with DOXYCYCLINE (in Vibramycin Capsules)

Blood clotting normally occurs in response to a cut or other types of injuries to protect the body from excessive bleeding. Many substances are involved in the clotting process including various chemicals that are produced in the body like vitamin K. Vitamin K is made by bacteria that are normally present in the intestinal tract and may also be supplied in the diet by eating green leafy vegetables, liver, and egg yolks. Doxycycline may kill the bacteria responsible for producing vitamin K. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When doxycycline and warfarin are used at the same time, your blood may be much less likely to clot and this may increase the risk of excessive bleeding. If these drugs are used together, your doctor may want to monitor you closely for signs of bleeding (bruising, nose bleeds, ect). Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin.Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

This interaction is poorly documented and is considered major in severity.

 

[CThrock]

Freddie. I was on DOXYCYCLINE and it did nothing to my INR. Don't panic just take your INR your usually time and do adjusting if need be.
Ross, gave you some good information just go from there.

 

[Freddie]

Thanks Gina and Ross,
but I'm already little on the 'high' side of my INR. I know, I know 4.3 or 4.1 isn't that high, just remember where I'm coming from - old school doctors.

And this the confusing part, the doc wants the INR lower and thinks this DOXYCYCLINE will raise my INR, hence the reason for lower my dosage, Is this other doctor a quack too?

 

[geebee]

If you are trying to get the 4.1 down a little, you could try 5mg for a couple days and then test. It is unlikely your INR would go too low and you can adjust from there. Just keep in mind that, once you are feeling better, you will need to change back since your eating and activity will go back to what it was.

Home testing is great but we can overthink sometimes. If you were lab testing once a month, you would probably never test at a level that would require a change and be just fine.

 

[Freddie]

Well..........I just got the 3rd and 4th degree from my regular doctor. I put in a phone call to her questioning my the change in my warfarin dosage.
She feels that I'm more concerned about forming a blood clot and that I am with bleeding. She is more concerned about an high INR and bleeding and so should I and what this other doctor prescribed and adjusting my dosage would be exactly what she would say.

man I hate this roulette game

I can see it happening again....anyone want to join me in this up and coming roller-coaster ride? grrrrrrrrr

 

[Freddie]

In your own opinion which is worse, forming a clot or having a bleed?
Maybe I DO have to change my way of thinking.

 

[geebee]

In your own opinion which is worse, forming a clot or having a bleed?
Maybe I DO have to change my way of thinking.

I am more concerned about a clot.

 

[Bina]

Freddie, your INR of 4.1 or 4.3 is fine for now, and I would not be trying to predict what a new med will or will not do.
That could end up biting you in the butt.
If you are concerned when starting a new med, do your home test about 3 days after starting the new med and go from there.
Are you taking antibs for a cold?

 

[catwoman]

Freddie:

Ask your doctors:

If you were the patient, what would you rather replace: blood cells ... or brain cells?

Say it very seriously.

I've repeated this to my doctors. None of them have ever heard our mantra here (You can replace blood cells, but you can't replace brain cells).

 

[Freddie]

Freddie, your INR of 4.1 or 4.3 is fine for now, and I would not be trying to predict what a new med will or will not do.
That could end up biting you in the butt.
If you are concerned when starting a new med, do your home test about 3 days after starting the new med and go from there.
Are you taking antibs for a cold?

Yes Bina, this new drug is for my cold/bronchitis

Freddie:

Ask your doctors:

If you were the patient, what would you rather replace: blood cells ... or brain cells?

Say it very seriously.

I've repeated this to my doctors. None of them have ever heard our mantra here (You can replace blood cells, but you can't replace brain cells).

Marsha, I did said that a few weeks ago when I had my little stint in the ER. The ER doc was not amused and said some smart ass remark, something like "the idea is not to loose brain cells".

I am really peeed off right now, cause there were other matters that were said during that conversation with my doc.
Sometimes I wish I didn't have a French temper!

 

[Herb M]

I would take 1/2 dose for one day. Check in a few days. If that doesn't do it, I would then take half of daose for two days during the week. Yjay should get you in range. If it gets too low, do 1/2 dose for one day.

I do not listen to the recommendations of my physician. She is always wrong in adjusting my dose. I rely on the algorithms from Al Lodwick and I do fine.

 

[catwoman]

Marsha, I did said that a few weeks ago when I had my little stint in the ER. The ER doc was not amused and said some smart ass remark, something like "the idea is not to loose brain cells".

I am really peeed off right now, cause there were other matters that were said during that conversation with my doc.
Sometimes I wish I didn't have a French temper!

Duh -- yeah, the idea is not to lose brain cells. I have discussed this with my doctors and they do see my point. And they have expressed fears of having a stroke and losing their ability to speak, move, think, etc. -- and continue earning their livelihood.

French temper? My ex was of French Canadian descent. I believe his grandfather was born in Canada. But they had lived in Massachusetts long enough to lose that French temper.

 

[lance]

Take a deep breath ...............

Take a deep breath ...............

start your new drug and test your blood in a couple of days and if necessary make an adjustment then.

Learn everything you can about INR management and when a doctor gives you "inappropriate" advice you will have enough confidence to state your case and hold your ground.

My dose is almost twice the amount you take in a day/week and my range is 3.5-4.0. Recently an ER doctor told me to "hold" two days for a reading of 4.1 because he assumed, without asking, my range was 2-3 and I take warfarin for arrhythmia The appropriate dose adjustment was 2 mg for for one day

An acquaintance of mine suffered a blood clot in her groin following knee replacement on the other leg. The leg with the clot is twice the size of the "normal" leg and there's a chance it won't return to its normal size, ever. Should that clot move she could be killed just because instead of putting her on warfarin they used an anti-coagulant "being studied". And they told her because she's on oxycontin for pain she can't take aspirin. When I took oxcycontin for what turned out to be an abcessed tooth I never noticed any differece in my INR at all.

Wait and see and you will be just fine.

 

[Freddie]

This is where the frustration comes in:
I did suggest (didn't demand) to wait and see if this new drug would have any effect with my INR, the response I got was "your already too high so your dose has to be lowered anyhow..... your not going to drop below 2.0 in 5 days. Going below 2.0 for more than 5 days will increase your chance of forming a clot and in your case you should be more concerned in having a bleed than forming a clot."

The conversation got a little heated over other matters were mentioned - blah, blah, blah and I haven't told her about receiving my monitor yet. How am I going to explain that one? She wont even look at the sources you all shared with me from a while back. In her mind and research she is convinced that monitors are not accurate enough for my range.

I think I need a bigger shovel, I'll be in need of a bigger hole

 

[Bina]

When i have an INR of 4.1 the next meal includes more broccoli. Simple.
And Freddie, share the fact with doc that you are the proud owner of a monitor.
If she does not see this as a bonus, there is something wrong. She is a control freak.

 

[njean]

Do some or all of you that have home monitors, report your INR results to your drs??

Just curious because I have never reported my results to anyone in the two years that I've had my monitor. Whenever I have a checkup w/the cardio dr. he will ask me what the number was on my last INR check & that's it.

 

[njean]

.....and I'm sorry for trounching on your thread Freddie! I apologize!

 

[Bina]

My doc is very organized, but laid back.
I give him results about every 3 months or when I remember.
He has it all on file, and so do I. Works perfect.